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Biomedical subjects

E Di Segni

Publications and source records attributed to E Di Segni.

At least 37 records · Page 2Linked to original sources
PubMed1989

The mechanism of the obstruction in calcific aortic stenosis with bicuspid valve: a reason for failure of balloon aortic valvuloplasty in the elderly.

Percutaneous aortic balloon valvuloplasty failed to relieve the obstruction in 2 elderly patients with calcific aortic stenosis. Intraoperative and pathologic examination showed bicuspid aortic valve with symmetric cusps, straight and fibrotic cusp edges and fractured calcific nodules of the aortic valve. Failure of balloon valvuloplasty in these patients, in spite of successful fractures of calcific nodules, was due to inability to influence the spring-like action of the thickened edges of the valve which represents a specific additional cause of obstruction in calcific bicuspid aortic valve of the elderly.

Aged↗
PubMed1988

Subcostal cross-sectional echocardiographic imaging of patent ductus arteriosus.

A modified subcostal short-axis cross-sectional echocardiographic view for imaging the patent ductus arteriosus (PDA) was studied. A total of 22 newborns with PDA and various associated cardiac anomalies and 16 newborns without PDA were examined. The PDA was imaged in the subcostal view in 19 newborns. In the control group, the absence of the PDA was established in 13 newborns and considered probable in three. The PDA was optimally imaged in the subcostal view in patients with normal or enlarged pulmonary artery, mainly those with the hypoplastic left heart. Among the eight patients with small pulmonary artery (pulmonary atresia or severe tetralogy of Fallot), the PDA was imaged in the subcostal view in three and in the suprasternal view in eight. By combining the suprasternal and the subcostal views, the PDA was imaged in each instance.

Ductus Arteriosus, Patent↗
PubMed1988

Paroxysmal heart block triggered by sitting up: a usually undetected cause of cerebral ischemia.

Modest postural changes may trigger symptoms of cerebral ischemia, and these are usually attributed to "postural hypotension." The mere act of sitting up in bed induced paroxysmal atrioventricular block with symptoms sufficiently severe to warrant pacemaker implantation, without changes in blood pressure, in two patients. These cases illustrate an easily treatable mechanism for posturally induced cerebral ischemia that may completely escape clinical detection if not looked for.

Aged↗
PubMed1986

Double mitral valve orifice.

A two-day-old baby with a type-I truncus arteriosus and double mitral valve orifice is reported. The double mitral valve orifice and additional lesions of each subdivision of the mitral valve were clearly shown by two-dimensional echocardiography. The medial orifice had a cleft leaflet and the lateral one a parachute-like disposition of the tension apparatus. This is the first report of double mitral valve orifice associated with truncus arteriosus, and the first in which anomalies of the subdivisions of the mitral valve were detected by two-dimensional echocardiography.

Echocardiography↗
PubMed1986

Ultrasonic real-time diagnosis of transitory fetal pleural and pericardial effusion.

Congenital fetal effusions are rare and often fatal. Prenatal ultrasonic diagnosis is an important factor in both diagnosis and management of this condition. We report a case with both pleural and pericardial effusion, the ultrasonic diagnosis and follow-up, and the birth of a healthy baby. A short review of the literature is given.

Adult↗
PubMed1983

Cleft anterior leaflet of the mitral valve with intact septa. A study of 20 cases.

Twenty pathologic specimens of heart, each with a cleft in the anterior leaflet of the mitral valve not associated with septal defects of persistent common atrioventricular canal (isolated cleft of the mitral valve), were studied. In 9 cases, there were either no associated anomalies or ones not of functional significance. In each of the other 11 cases there were other significant associated cardiac anomalies, including ventricular septal defect and d-transposition of the great arteries. Functional consequences of the mitral anomaly were mitral insufficiency, subaortic stenosis, or both. Mitral insufficiency was related principally to the width of the cleft. Subaortic stenosis, when present, was due to the position of insertion of accessory chordae in the ventricular septum in a position under the commissure, between the left and right aortic cusps or under the right aortic cusp.

Adolescent↗
PubMed1983

Isolated cleft mitral valve: a variety of congenital mitral regurgitation identified by 2-dimensional echocardiography.

Nine children with isolated cleft mitral valve, aged 1 day to 12 years, were studied. The electrocardiogram showed a normal QRS axis in 5 subjects. Cardiac catheterization was performed in 4 patients and demonstrated severe mitral insufficiency in 3 but failed to clearly demonstrate a cleft mitral valve or gooseneck deformity. The mitral cleft was confirmed at operation in 2 patients. Two-dimensional echocardiography demonstrated a cleft dividing the anterior mitral leaflet into 2 portions in each patient. The mitral anulus was normally positioned and the atrioventricular septum present. Atrial and ventricular septa were intact. Features similar to anatomic studies such as accessory chordae and thickening of the edges of the cleft with increasing age were also seen. Two-dimensional echocardiography is the only method available to reliably diagnose isolated cleft of the mitral valve.

Cardiac Catheterization↗
PubMed1983

Verapamil improves exercise capacity in chronic atrial fibrillation: double-blind crossover study.

Oral verapamil has previously been shown to reduce heart rate at rest and during mild exercise in chronic atrial fibrillation. Its efficacy in improving cardiovascular performance at higher levels of exercise and its safety were investigated in a prospective, randomized, placebo controlled double-blind study preceded by an open label titration phase in 20 digitalized patients with chronic atrial fibrillation. Maximal exercise capacity was improved (from 522 +/- 257 to 806 +/- 348 work units, p less than 0.0005) when tested by a standardized multistage ergometry exercise test. Heart rate was also reduced at rest, at the end of 3 minutes of 300 KPM exercise, and at the point of maximal exercise. Blood pressure and double product were also reduced. Its efficacy and safety may make verapamil the treatment of choice in chronic atrial fibrillation.

Adult↗
PubMed1983

The early recognition of right ventricular infarction: diagnostic accuracy of the electrocardiographic V4R lead.

The sensitivity and specificity of ST-segment elevation in the right precordial lead V4R as an early indicator of right ventricular infarction were examined in a consecutive series of 110 patients admitted for acute inferior myocardial infarction. The sensitivity was 82.7%, the specificity 76.9% and the positive predictive value 70% in 58 patients with right ventricular infarction documented by autopsy or a combination of radionuclide ventriculography and one or more of the following tests: echocardiography, technetium-99m pyrophosphate scintigraphy and hemodynamic monitoring. The negative predictive value was 87.7%. Because of its simplicity and its high sensitivity and specificity, recording of V4R should be an intrinsic part of the early evaluation and electrocardiographic examination of acute inferior wall infarction.

Adult↗
PubMed1983

Superiority of oral verapamil therapy to digoxin in treatment of chronic atrial fibrillation.

The efficacy and safety of oral verapamil, 240 mg, with or without digoxin were studied in 52 patients with chronic atrial fibrillation at rest, and during mild and maximal exercise. Twenty-four patients were studied during the following therapeutic modalities: no therapy; digoxin, 0.25 mg and 0.5 mg daily; digoxin, 0.25 mg and verapamil; and verapamil alone. Heart rate at rest and during all levels of exercise was decreased significantly (p less than 0.005), either by combining digoxin with verapamil or by verapamil therapy alone. In contrast, the excessive heart rate response to exercise was not prevented by digoxin even with good serum concentrations. The improved control of heart rate with verapamil was associated with a significantly improved exercise capacity. Verapamil is an important and safe modality of treatment, with or without digoxin, in the long-term control of heart rate in chronic atrial fibrillation. It is superior to digoxin in controlling the ventricular rate and in improving exercise capacity.

Administration, Oral↗
PubMed1982

Identification of normal and transposed great arteries by contrast M-echocardiography in the newborn: a combined suprasternal and precordial approach.

Diagnosis of complete transposition of the great arteries (TGA) by M-mode echocardiography depends on the correct identification of the aorta and the pulmonary artery at their roots. We describe a contrast M-mode echocardiographic technique which combines suprasternal and precordial views in which the two great arteries are visualized simultaneously. After venous injection of 1-3 ml 5% dextrose, the sequence and relative intensity of opacification of the great arteries are recorded in both views and then matched to each other. Because in the suprasternal view the aorta is always superior and the pulmonary artery inferior, the characteristics of opacification of these two arteries in the suprasternal view are used as markers for their proper identification in the precordial view. In four normal newborns contrast medium filled only the pulmonary artery. In six newborns with cardiovascular malformations with shunts and normally related great arteries, in which the contrast medium preferentially filled either the aorta (five patients) or the pulmonary artery (one patient), matching the record from the precordial view to that from the suprasteral view proved that the anterior vessel was indeed the pulmonary artery, and the posterior vessel the aorta. In five newborns with d-TGA the contrast medium preferentially filled the aorta, and the combined suprasternal and precordial approach proved that the aorta was anterior and the pulmonary artery posterior. This method is independent of the direction of venous drainage or site of injection.

Aorta↗
PubMed1982

The supernormal phase of intraventricular conduction: normalization of intraventricular conduction of premature atrial beats.

This report presents the analysis of a case in which numerous atrial extrasystoles, associated with normal intraventricular conduction, occurred during sinus rhythm conducted with right bundle branch block. The wide overlap of coupling intervals of normally conducted extrasystoles and other extrasystoles with right bundle branch block seemed prima facie to negate the possibility of supernormality. Rearrangement of these intervals, however, to allow for the timing of right bundle branch depolarization with respect to the ensuing QRS complex, resulted in a clear cut separation of all normalized complexes from those with right bundle branch block. All normalized extrasystoles were localized in a zone very early in the cycle. This finding, in the presence of atrial extrasystoles with normal P-R intervals, strongly supports the mechanism of supernormality in this case. Alternate explanations do not appear to be tenable.

Aged↗
PubMed1982

The influence of verapamil on serum digoxin concentration.

The effect of verapamil on the pharmacokinetics of digoxin was studied in 49 patients with chronic atrial fibrillation. A dose of 240 mg/day of verapamil was given to the patients who were receiving a stable dose of digoxin. Serum digoxin levels rose from 0.76 +/- 0.54 ng/ml (mean +/- SD) to 1.31 +/- 0.54 ng/ml during verapamil treatment (p less than 0.0005). This effect was dose-dependent, as shown in seven subjects who received 160 mg and then, 240 mg of verapamil: There was a stepwise rise in serum digoxin concentration from a control value of 0.60 +/- 0.11 ng/ml to 0.84 +/- 0.18 ng/ml and 1.24 +/- 0.40 ng/ml, respectively (p less than 0.01 for both steps). The effect of verapamil developed gradually within the first few days in seven subjects in whom serum digoxin concentration reached, within 7 days, 90% of the increase observed 14 days after onset of verapamil. Renal digoxin clearance decreased significantly (26.1 +/- 0.7 vs 55.1 +/- 12.3 ml/min, p less than 0.005) in six patients in whom serum digoxin concentration increased. It did not change in one patient in whom serum digoxin concentration was not influenced by verapamil. Creatine clearance did not change in any of these seven. The same effects on digoxin clearance were observed in three normal subjects. Among the 49 patients, verapamil resulted in the development of signs and symptoms that suggested digitalis toxicity in seven. Verapamil significantly increased serum digoxin concentration. The process is dose-dependent and gradual, and it is at least partially explained by reduced renal excretion without reduction in glomerular filtration. The dose of digoxin may need readjustment in patients who are concomitantly receiving verapamil.

Adult↗
PubMed1981

The use of the balloon-tipped floating catheter in temporary transvenous cardiac pacing.

The effectiveness and safety of balloon-tipped, flow guided, electrodes for ventricular pacing as opposed to the fluoroscopy-guided semi-rigid bipolar electrodes have never been compared in a controlled study. A prospective study was therefore undertaken to compare both techniques in semi-elective and emergency procedures. Flow guided electrodes were inserted in 67 patients (group A) and semi-rigid electrodes in 44 patients (group B). The results of group A were judged to be superior to those of group B in four aspects: a) shorter time (6'45" vs. 13'30", p less than 0.0005); b) lower incidence of catheter displacement (13.4 vs. 32.0 percent, p less than 0.05); c) longer interval of time between implantation and catheter displacement (4.4 vs. 1.9 days, p less than 0.0005); d) lower incidence of serious ventricular arrhythmias during insertion (1.5 vs. 20.4 percent, p less than 0.005). Threshold at insertion was not significantly different (0.6 +/- 0.3 vs 0.7 +/- 0.2 milliampere). The superiority of flow-guided electrodes over fluoroscopy-guided electrodes persisted in the comparison of semielective insertions in groups A and B. We conclude that the flow-guided insertion technique is safer, more expeditious and more stable than the fluoroscopy-guided technique in semi-elective as well as in emergency insertions.

Adolescent↗
PubMed1981

Mid-systolic click and echocardiographic evidence of mitral valve prolapse during electrical pacing.

A mid-systolic click was present in a patient during three years of follow-up after implantation of a permanent transvenous pacemaker. Echocardiography revealed posterior motion of the anterior leaflet which resembled mitral valve prolapse. Both the click and echocardiographic evidence of prolapse disappeared simultaneously with resumption of sinus rhythm and during supraventricular tachyarrhythmias. Wtih spontaneous change in the position of the electrode three years after initial implantation, both the click and the posterior motion of the mitral valve disappeared. The association of mitral valve prolapse with electrical pacing is most unusual and appears to have a distinct pathophysiological mechanism.

Aged↗